SAFETY AND HEALTH STANDARD KUC ELECTRICAL STANDARD Effective Date: 04/4/12 Standard: 15.1 Document Number: KUCSH0065 Rev: 06

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1 15.1 INTRODUCTION This standard is intended to provide guidelines regarding safe electrical work procedures, electrical competency requirements, access to electrical "controlled areas", grounding, and verification of grounding integrity, portable electric equipment, and electrical transmission lines. This standard applies to all electrical work above 110 volts DC or 50 volts AC DEFINITIONS COMPETENT PERSON- a person having demonstrated the knowledge and abilities that fully qualify them to perform the duty to which they are assigned and who because of training and experience is capable of identifying hazardous or dangerous conditions and of instructing other employees to identify such conditions AUTHORIZED PERSON- a person approved or assigned by plant management to perform a specific duty or to be at a specific location QUALIFIED PERSON A person who, by possession of a recognized degree, professional certificate, or who, by extensive knowledge, training, and experience in the applicable field, has successfully demonstrated the ability to solve or resolve problems and is capable of design, analysis, evaluation and specifications relating to the subject matter, the work, or the project TRAINED PERSON A person who has successfully completed an approved course related to the subject. Records of the training must be maintained to verify trained person status ELECTRICAL GROUNDING - connected to or in contact with earth, or connected to some extended conductive body that serves in place of earth, to provide a path for leakage and / or fault currents to prevent an objectionable potential above ground on non-current carrying metal parts GROUNDING SYSTEMS - typically include the following: o Equipment grounding conductors - the conductors used to connect the metal frames or enclosures of electrical equipment to the grounding electrode conductor. o Grounding electrode conductors - the conductors connecting the grounding electrode to the equipment grounding conductor. Page 1 of 20 Plant:

2 o Grounding electrodes - usually driven rods connected to each other by suitable means, buried metal, or other effective methods located at the source, to provide a low resistance earth connection REQUIREMENTS All electrical installation work shall be conducted by competent personnel in accordance with governing regulation, code, design criteria and safe work procedures There shall be demonstrated job and equipment-specific electrical competency standards and safe work procedures for all electrical work, i.e. construction, decommissioning and demolition of electrical equipment. The competency standards shall specify the frequency for re-certification, which shall be no less than every two years and address job and equipment-specific safe work procedures There shall be an arc flash protection program in place to determine incident energies and define the appropriate PPE and associated procedures to mitigate the hazard Electrical safety devices such as earth leakage and overload protection shall be installed on all final distribution circuits and the settings established by qualified personnel Electrical equipment, grounding continuity and electrical safety devices shall be inspected and / or tested on a suitable schedule and the findings recorded There must be a system for removing electrical equipment unfit or unsafe for purpose. Each plant shall establish a system for removing unfit or unsafe electrical equipment There must be a system for maintaining an up-to-date set of single line diagrams with supporting documentation showing: o System fault calculations; o Equipment details; o Electrical protection discrimination curves; and o Cable ratings. Pertinent revisions shall be properly engineered, approved and logged. (See Exhibit ) Ongoing updates to distribution panel schedules, fault calculations, equipment details, protection discrimination curves and cable ratings must also be engineered, Page 2 of 20 Plant:

3 approved and logged Equipment shall be isolated. All energized electrical work will require a safe work procedure and an Energized Electrical Work Permit with the exception of voltage testing and where no tools are used Access to an electrical cabinet or other enclosure with exposed energized terminals in excess of 1,000 volts is prohibited There shall be an assessment of overhead and underground power lines and a system in place to mitigate the hazards associated with working in close proximity, and to prevent contact by personnel or equipment. (See KUC Standard 16.4 Close Proximity Permit) Employees and contractors exposed to electrical hazards shall receive electrical hazard training at the commencement of their employment and thereafter on an annual basis. The training shall address the equipment and conditions specific to the work area of the personnel and be documented. o Welding where the open circuit voltage exceeds 110 volts DC or 50 volts AC will be considered Energized work unless an approved Voltage Reduction Device (VRD) or an electrode switching device with a trigger action is used The following policies and procedures apply to all electrical / motor control rooms containing switches, motor starters, breakers, fuses and their accessories, located near the point of entrance of supply conductors to a "building or other structure" or an otherwise defined as a controlled area, and intended to constitute the main point of control. o For purposes of this provision, a switch room / MCC room is defined as a room dedicated to electrical distribution and control equipment. If switchgear / MCC is located in a room or facility in which routine non-electrical operational and / or maintenance activities may take place, these are not considered controlled areas provided that: - The maximum voltage is less than 1,000 volts, the incident energy of any panel is no higher that Category 2, and the total amperage does not exceed 1,200 amperes. - Energized parts are inaccessible. - A system is in place to maintain arc flash and shock approach boundaries during maintenance activities. - The MCCs are protected from mobile equipment and other activities that may take place in the area. Page 3 of 20 Plant:

4 - Working space around the equipment must be maintained to provide safe access / egress at all times. - A risk assessment is in place that confirms that the MCC and potential activities are compatible without risk to personnel or equipment. - A list of such areas is maintained and approved by the site manager o Electrical panels, enclosures, control centers, substations and equipment shall be appropriately guarded, labeled, and made inaccessible (except for emergency shut off mechanisms) to unauthorized personnel. Areas containing such equipment are controlled areas. o Access to controlled areas shall be restricted to competent or authorized personnel only. Access, will be controlled by locked doors or other appropriate means. Where it is necessary for untrained personnel (e.g. visitors) to enter controlled areas there shall be a system for communicating the hazards and for escorting them with appropriately trained personnel. Contractors must have a permit to work in controlled areas. o Suitable "Danger" signs shall be posted at the entrance to all major electrical installations. Metal-enclosed switchgear, unit substations, transformers, pull boxes, connection boxes, and other similar associated equipment shall be marked with appropriate "Caution" signs. Principal power switches shall be labeled to show which units they control. The labeling shall be legible, durable and distinctive. o All electrical rooms shall be kept clean and orderly. All doors, inspection and cover plates on electrical equipment shall be kept in place at all times except during testing, installation or repairs. o All personnel doors will be equipped with panic hardware and swing outward to allow rapid egress in the event of an emergency. o Electrical rooms shall not be used as shop facilities, storage areas or lunchrooms. All electrical rooms will be posted as "NO SMOKING" areas. Combustible materials shall not be stored in any electrical room nor shall they be stored or allowed to accumulate within 25 feet of an electrical substation. Electric room engineering documentation and diagrams are acceptable but must be properly stored in racks or storage files. o Insulated platforms, insulating mats, or other electrically nonconductive material shall be kept in place at all switchboards and power-control switches where a shock hazard exists. Page 4 of 20 Plant:

5 o Working space around electrical equipment shall be provided in accordance with the National Electrical Code. Where there is access to exposed energized parts, measures such as deenergization or the use of insulated gloves or blankets shall be used in accordance with safe work procedures. o The electrical group is responsible for the upkeep, equipment integrity, maintenance and housekeeping of all electrical equipment and installations inside the electrical room GROUNDING The path from circuits, equipment, structures, and conduit or enclosures to ground shall be permanent and continuous, have ample carrying capacity to safely conduct the currents liable to be imposed on it, and have impedance sufficiently low to limit the potential rise above ground and to cause the operation of overcurrent devices to isolate the circuit. o Grounding grids and driven rod electrodes shall have a resistance to ground not to exceed 25 ohms. Where the resistance is above 25 ohms, two or more electrodes connected in parallel shall be used. o The resistance of a motor frame to grounded building steel shall not exceed one (1) ohm. o Electrical equipment shall be grounded in accordance with all applicable federal and state regulations, National Electric Code and National Electrical Safety Code requirements All structures, hardware, shield wires, and pole-mounted transformers shall be grounded All exposed metal parts of switches, structures, transformers, fences, gates, buildings, switchboards, breakers, meters, relays, lightning arresters, and communication equipment shall be grounded. o All substations shall have a ground grid to which all equipment is bonded. Resistance of grid to earth shall not exceed 25 ohms FIXED EQUIPMENT Equipment that is fastened in place or connected by permanent wiring methods. Exposed non-currentcarrying metal parts of fixed electrical equipment including motors, generators, frames, and rails of electrically operated cranes, electrically driven machinery, etc. shall be grounded. Page 5 of 20 Plant:

6 PORTABLE EQUIPMENT Equipment that is fed with portable cords or cables intended to be moved from one place to another. The non-current-carrying metal parts of portable and / or plugconnected equipment shall be grounded. o Portable electric-powered equipment such as conveyors, electric shovels, drills, etc. with associated portable substations, and switchgear shall be connected to a safety ground system. Trailing cables powering such equipment will have adequately sized ground conductors with continuously monitored ground continuity check equipment. o Portable tools and appliances protected by UL approved system of double insulation, or its equivalent, need not be grounded. Where such an approved system is used, the equipment shall be distinctively marked. o Extension cords used with portable electric tools and appliances shall be of three-wire type and shall be maintained in good condition PORTABLE and VEHICLE-MOUNTED GENERATORS - unless the owner s manual dictates otherwise, the frame of a portable generator shall not be required to be connected to a grounding electrode for a system supplied by the generator under the following conditions: o The generator supplies only equipment mounted on the generator, cord-and-plug-connected equipment through receptacles mounted on the generator, or both, and o The non-current-carrying metal parts of equipment and the equipment grounding conductor terminals of the receptacles are bonded to the generator frame. Vehicle-Mounted Generators - The frame of a vehicle shall not be required to be connected to a grounding electrode for a system supplied by a located on this vehicle under the following conditions: o The frame of the generator is bonded to the vehicle frame, and o The generator supplies only equipment located on the vehicle or cord-and-plug connected equipment through receptacles mounted on vehicle, or both equipment located on the vehicle and cord-and-plug connected equipment through receptacles mounted on the vehicle or on the generator, and o The non-current-carrying metal parts of equipment and the equipment grounding conductor terminals of the receptacles are bonded to the generator frame. Page 6 of 20 Plant:

7 Portable Welders - must be plugged into an approved receptacle and equipped with the following: o A disconnect switch or circuit breaker in the supply system. o A nameplate giving electrical data for the welder. o An approved welding lead All temporary wiring shall be effectively grounded in accordance with the National Electrical Code Operators / craftsmen shall conduct the following tests. (See attached procedure and recordkeeping forms Exhibit ) o Equipment grounding conductors - continuity and resistance must be tested immediately after installation, repair, or modification, and annually if conductors are subjected to vibration, flexing, or corrosive environments. o Grounding electrode conductors - continuity and resistance must be tested immediately after installation, repair, or modification, and annually if conductors are subjected to vibration, flexing, or corrosive environments. o Grounding electrodes - resistance must be tested immediately after installation, repair, modification, and annually thereafter Conductors in fixed installations, such as rigid conduit, armored cable, raceways, cable trays, etc. that are not subjected to vibration, flexing, or corrosive environments may be examined annually by visual observation to check for damage in lieu of the annual resistance test Grounding conductors in trailing cables, power cables, and cords that supply power to tools and portable or mobile equipment must be tested. This requirement does not apply to double insulated tools or circuits protected by ground-fault-circuit interrupters (GFCI) Testing of equipment grounding conductors and grounding electrode conductors is not required if a fail-safe ground wire monitor is used to continuously monitor the grounding circuit and which would cause the circuit protective devices to operate when the grounding conductor continuity is broken PORTABLE ELECTRICAL EQUIPMENT The exposed non-current carrying metal parts of portable and / or plug-connected tools, welders and other equipment must be Page 7 of 20 Plant:

8 grounded. o Portable tools and appliances with an approved system of double insulation need not be grounded. To avoid the grounding requirements the item being used must be clearly marked as being double insulated Hand-held power tools must be inspected before each use for damage or alteration. Unsafe conditions must be corrected before the tool is used. o Hand-held power tools such as power drills, disc sanders, grinders, circular saws, and chain saws when used in the hand held mode shall be operated with controls which require constant hand or finger pressure. o Hand-held power tools shall not be operated at voltages above 120 volts. o Disconnect tools when not in use, before servicing and cleaning, and when changing accessories such as blades, bits, and cutters. o All factory installed guarding must be in place when operating any hand tool Electrical cords must be protected from physical damage. Before use power cords must be inspected for missing ground prong and damaged insulation or damage to the plug or receptacle and be current with the grounding continuity verification requirement JUMPER PERMIT Jumpers can be used on any interlock, contact, loop, etc. that has temporarily been put out of service. This includes hardwire and software types. Jumpers can only be installed by trained electrical or control systems employee(s) or other qualified and authorized personnel designated by plant management Prior to installation of the jumper, a "Jumper Permit / Jumper Tag" (see Exhibit ) must be completed and approved by an authorized person as designated by plant management. The completed Jumper Permit will be forwarded to the electrical supervisor for inclusion in the Jumper Log The Jumper Tag must be placed on the device or inside the panel where the jumper is contained. For software jumpers (or temporary modification), the Jumper Tag must be placed in the PLC / CPU rack. When a control system technician or electrician removes a jumper, the tag must be returned to the electrical Page 8 of 20 Plant:

9 supervisor and the Jumper Permit updated that the jumper was removed A Jumper Log must be maintained by the electrical supervisor or other plant designee. The log must contain all pertinent information, including dates jumpers were installed and removed with a copy of the Jumper Permit. The record log must be kept for a minimum of two years Under no circumstances will a jumper be used to bypass an emergency safety shutdown device, e.g., pull cord switch, stop button, etc. Also, jumpers will not be used to deactivate or circumvent an activated lock out system. Whenever installing a jumper that may affect personnel safety a risk assessment must be completed Precautions must be taken on equipment when protection devices are jumpered, e.g., lube flow switches, RTDs, etc.; precautions could include more frequent interval inspections of equipment, temporary replacement devices, or constant employee watch. In any case, the risk of equipment loss must be reduced to the maximum extent possible ELECTRICAL TRANSMISSION LINES Grounding - Wood structures shall have a copper butt plate and spiral wrapped with a minimum #6 AWG soft-drawn copper wire up to ground level. Spiral wraps shall be short-circuited together by the vertical ground wire and stapled at every crossing. The wire is to be extended straight up the pole and stapled at no more than three foot intervals. All hardware and shield wires shall be connected to pole ground wires. o Steel lattice-type towers shall be grounded through the steel structure. Bolted joints shall be inspected for tightness at such intervals as experience has shown to be necessary. o Tubular steel towers shall be grounded through anchor bolts and grounding lugs provided. o Ground resistance should be monitored at strategic locations and records kept All transmission lines shall have shield or static wires in place. Shield wires shall be extra high strength galvanized steel or copper-clad steel, as determined by location and shall be securely connected to structure ground conductors. Lightning arrestors shall be installed at transformer bank primaries, fused disconnects, and in substations. Page 9 of 20 Plant:

10 Warning signs must be posted on all steel transmission line towers. Signs shall be mounted at a height of 5 to 7 feet on all four sides of the tower. These signs shall clearly indicate Danger and High Voltage Climbing steps will be installed on steel structures, if needed, and will begin at a point at least 12 feet above ground level. Steps below 12 feet high will be removed. Steps will not be installed on wood poles. Structures accessible by the public will have steps beginning at 15 feet above ground level, if steps are required Vertical and horizontal clearances between power lines and ground or other obstructions will be in accordance with published standards, taking into account line voltage, structure type, loading class, span length, type of terrain, and all other applicable constraints. o Approved clearances will be maintained between energized conductors and grounded structure parts. Energized conductors with less than minimum clearance will be shielded or insulated to protect personnel and equipment. Safety hazard signs shall also be posted. o Any powerline that could be an obstruction to air navigation will be identified by marker balls. This includes overhead lines exceeding 200 feet above ground level. In the event of a valley, ravine or gorge, the lowest point is used to determine elevation. - Markers should be spaced equally along the wire at intervals of approximately 200 feet or fraction thereof Insulation of energized conductors from structures shall be installed in accordance with operating voltage, impulse level required, and ambient conditions All transmission lines shall be visually inspected at such intervals as experience has shown to be necessary. Inspections shall be documented and corrective action shall be promptly taken to correct problems identified during the inspection. o Switches shall be exercised at such intervals as experience has shown to be necessary An infrared thermographic survey of all transmission lines shall be conducted at such intervals as experience has shown to be necessary. Any hot spots discovered in the thermographic survey shall be promptly corrected. Accurate records of location, equipment, and temperature rise shall be taken and maintained. Page 10 of 20 Plant:

11 Areas around wood poles subject to weed growth shall have an environmentally-acceptable herbicide applied in a six-foot radius around each pole at intervals as necessary to control weeds and eliminate danger of pole damage from ground fires Guy wires on wood poles shall have insulators installed at 8 feet above ground level to protect personnel. Guy wires shall be adequately marked and protected from damage Line work shall be performed only by qualified linemen. o Tools and safety equipment shall be inspected and tested at prescribed intervals. o Wherever possible, before line work is begun, the line will be isolated and grounded according to the KUC Lock and Tag Standard 16.12, Kennecott Electrical Switching Procedures, and the Kennecott Substation and Switchyards Manual. o Hot line work, if required, will be performed in strict compliance with established procedures New construction and maintenance shall conform to all applicable requirements contained in this standard and all other codes and regulations ILLUMINATION Adequate illumination shall be provided for all working spaces around electrical equipment. Whenever possible, natural lighting should be utilized in all working areas. Artificial lighting must be adequate for the type of work being performed in an area, especially where hazardous or night work situations are involved. Energy efficient lighting products must be considered whenever changing existing lighting or designing new lighting layouts. Illumination levels should be maintained to the latest ANSI Lighting Standards RECORDKEEPING A record of the most recent continuity and resistance test or visual examination conducted must be kept and made available for internal and regulatory inspections. The records shall: o Identify the equipment and location tested o Identify the person conducting the tests o Identify the date of the test o Record meter reading to the nearest 0.1 ohm Page 11 of 20 Plant:

12 o Identify action taken to address readings over one (1) ohm o Record a re-test reading upon completion of repairs Recordkeeping forms are provided as attachments to this standard. All records shall be maintained as designated in the KUC Records Retention Schedule. REFERENCES: American National Standard Practice for Industrial Lighting ANSI RP7 FAA Part 77 Airspace Obstruction Analysis FAA Obstruction Marking and Lighting KUC Safety and Health Standards 16.4 Cranes and Hoists KUC Safety and Health Standard Lockout / Tagout (Isolation) KUC Records Retention Schedule MSHA 30 CFR Part 56 & and Subpart K National Electrical Code NFPA 70 National Electrical Safety Code OSHA 29 CFR Subpart S. Rio Tinto Safety Standard C2 Electrical Safety Rio Tinto Electrical Standards Guideline Document REVISION HISTORY: MOC# Description of Change Prepared By Date Scheduled review and update including adding a procedure for continuity and resistance testing recommended by the C2 Standards Committee. Also, updated format and Document number added. KUC Safety and Health Standards Committee 6/ Scheduled review and update. Also changes incorporate requirements from combining the existing KUC H&S Standards 15.2 Lighting, 16.9 Portable Electric Equipment, Electrical Grounding, Jumper Permit and Electrical Transmission Lines (which will be eliminated) into C2 Electrical Safety Champion KUC Safety and Health Standards Committee 03/12 Page 12 of 20 Plant:

13 Exhibit Log of Engineering Revisions Plant: Page 1 of Discipline: Item Drawing/ Rev. Date Description APPROVALS No. PLC ID # (a) 1 No. (b) (c) Procedure for updating Programmable Logic Controller (PLC) software: Diskette label must show Rev. number(s), same Rev. # as shown in this log. (a) Shaded areas reserved for related PLC revision (b) Supervisor / Plant Engineer (c) Plant Engineer s supervisor (next level in organization) Page 13 of 20 Plant:

14 Exhibit Procedure for Testing Continuity and Resistance of Grounding Systems Continuity and resistance of grounding systems shall be tested immediately after installation, repair, or modification; and annually thereafter. A record of the resistance measured during the most recent test shall be made available for inspection and records shall be kept on file in accordance with the KUC records retention policy. Fixed Plant Equipment Annual Inspection (A) Equipment Needed a. Digital or analog volt-ohmmeter b. Spool of copper wire of appropriate length with alligator clamps or equivalent suitable connectors at each end (B) Zero Meter Through Wire Roll a. Attach one end of wire to meter b. Attach opposite end of wire to other meter probe c. Measure resistance of wire d. Adjust meter reading to 0 or record reading to deduct from overall resistance readings (C) Visually Inspect Grounding System and Repair as Needed a. Check for obvious signs of corrosion b. Check for broken conduit or flex c. If external grounds are present, inspect for damage (D) Record Meter Reading at Motor a. Attach one end of wire roll to grounded building steel ensuring good contact b. String out sufficient wire to reach motor and attach to meter probe c. Place other meter probe on motor housing ensuring good contact d. Record meter reading to the nearest 0.1 ohm (deduct wire roll resistance if meter not zeroed ) e. If resistance is higher than one (1) ohm, identify and correct deficiency (E) Clamp on Ground meter a. A ground resistance tester may be used in lieu of the above method to measure the resistance of the grounding system Repair or Modification (A) Measure the Resistance of the equipment grounding conductor when disconnected a. Use method A-D above but connect one probe of meter directly to the grounding conductor instead of the motor case b. After the motor is connected and before energizing measure resistance of grounding system using A E above (Annual Inspection) (B) Whenever grounding connections are visible or exposed during routine maintenance or troubleshooting, the grounding connections must be visually inspected. Page 14 of 20 Plant: effect and supersede all other revisions.

15 Portable Equipment - If not connected to a ground monitoring system (A) Equipment Needed a. Digital or analog volt-ohmmeter b. Spool of copper wire of appropriate length with alligator clamps or equivalent connector at each end (B) Zero Meter Through Wire Roll a. Attach one end of wire to meter b. Attach opposite end of wire to other meter probe c. Adjust meter reading to 0 or record reading to deduct from overall resistance readings (C) Visually Inspect Grounding System a. Check for obvious signs of corrosion b. Inspect feeder cable and connections for damage (D) Record Meter Reading at Motor a. Attach one end of wire to the MCC ground feeding the power cable, ensuring good contact b. String out sufficient wire to reach motor and attach to meter probe c. Place other meter probe on motor housing ensuring good contact d. Record meter reading to the nearest 0.1 ohm (deduct wire roll resistance if meter not zeroed ) e. If resistance is higher than one ohm, identify and correct deficiency Grounding Electrode Conductor The continuity and resistance of the equipment grounding conductors shall be measured by an inductive device or resistance reading between the frame of the motor and grounded building steel with a resistance of less than one (1) ohm Grounding Electrode The resistance of the grounding electrode or grounding electrode conductor to the earth shall be measured either by reference to an established earth-grounded electrode or inductive device (clamp on ground meter) with a resistance of less than 25 ohms Building Steel to Grounding Electrode Conductor The conductors between the building steel and the ground grid shall be visually inspected and the resistance determined by either an inductive device or a resistance meter between the building steel and the grounding electrode. Exposed steel to grid conductors should be visually examined for the condition of bonds and wiring, and of these, a representative number should be measured. Inspection or Repair When electrical equipment such as switchboards, panelboards, control panels, meter socket enclosures and motor control centers cabinet are accessed for inspection or repair, a visual inspection of the equipment grounding conductors shall be conducted. Page 15 of 20 Plant: effect and supersede all other revisions.

16 Exhibit (Designate Plant for Identification) CONTINUITY AND RESISTANCE GROUND SYSTEM LOG MODIFICATIONS AND / OR REPAIRS DATE ELECTRICIAN (S): SUPERVISOR: MODIFICATIONS LOCATION: REASON: DESCRIPTION: TEST READINGS: REPAIRS LOCATION: REASON: DESCRIPTION: TEST READINGS: NEW INSTALLATION LOCATION: REASON: DESCRIPTION: TEST READINGS: COMMENTS: Distribution: Maintenance Superintendent Plant Records Page 16 of 20 Plant: effect and supersede all other revisions.

17 Exhibit EQUIPMENT GROUNDING CONTINUITY AND RESISTANCE ANNUAL TESTING PROGRAM PLANT: EQUIPMENT NUMBER LOCATION/DESCRIPTION MOTOR FRAME TO BUILDING STEEL (OHMS TO 1 DECIMAL) PERSON PERFORMING TESTS DATE COMMENTS Distribution: Maintenance Superintendent Plant Records Page 17 of 20 Plant:

18 Exhibit ANNUAL GROUNDING SYSTEM INSPECTION RECORD USING VISUAL OR CONTINUITY / RESISTANCE READING METHODS PLANT: DESCRIPTION/ LOCATION METHOD: VISUAL OR OHM READING PERSON PERFORMING TESTS DATE COMMENTS Distribution: Maintenance Superintendent Plant Records Page 18 of 20 Plant:

19 Exhibit KENNECOTT UTAH COPPER JUMPER PERMIT (Standard15.1) Rev 6 02/12 TAG NO. EMOC # EQUIPMENT NUMBER DATE DEVICE JUMPERED TIME AM PM Work Order No. Hardwire? q Yes q No Software? q Yes q No Duration of Permit From To Reason for Jumper: Recommendations concerning safety, operating restrictions, or special instructions: APPLICABLE INFORMATION: Location & Equipment Description DWG MCC Term. Box Wire No. PLC External Force: Cabinet Block I/O Point PLC Software: PLC ID No. Rung I/O Point Requested By Print Name Signature Date Approved By Installed By JUMPER REMOVAL Removed By Print Name Signature Date Distribution Electrical Supervisor Page 19 of 20 Plant: effect and supersede all other revisions.

20 TAG NO. JUMPER TAG TRACK completed for this task (Initials): APPROVED BY EQUIPMENT NO. INSTALLED BY DATE TIME AM NOTE: RECORD ALL INFORMATION IN JUMPER LOG BOOK. PM Page 20 of 20 Plant: effect and supersede all other revisions.